GUILLAIN BARRE SYNDROME “GBS”

Question 1

GUILLAIN BARRE SYNDROME

“GBS”

Answer 1

is the most common cause of rapidly evolving motor paresis and paralysis and sensory deficits

Question 2

Individuals affected typically

Answer 2

reach maximal weakness within 2 to 3 weeks and spend weeks to months recovering

Question 3

The most common form of GBS is

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also known as acute inflammatory demyelinating polyradiculoneuropathy (AIDP)
GBS was once classified as a single entity characterized by PNS demyelination but now it is defined by several heterogenous forms

Question 4

Occurs at all ages but

Answer 4

peaks in frequency can be seen in young adults and in the fifth through eighth decades
Annual incidence of GBS varies from 1 to 2 cases per 100,000

Question 5

the primary target of attack is

Answer 5

Myelin of the Schwann cell

Question 6

Pathogenesis

Answer 6

Lesions occur throughout the PNS from the spinal nerve roots to the distal termination of both motor and sensory fibers
Myelin of the Schwann cell is the primary target of attack
An inflammatory response is initiated by circulating antibodies that bind to the surface of the myelin; lymphocytes (T cells) and macrophages are the inflammatory cells present
Demyelination occurs because macrophages responding to inflammatory signals, strip myelin from the nerves
After the initial demyelination, the body initiates a repair process
In addition to demyelination, axonal degeneration to so

Question 7

Clinical Manifestations

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The “classic” presentation is an acute form in which the time from onset to peak impairment is 4 weeks or less

Question 8

symptoms are characterized by

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a rapidly ascending symmetric motor weakness and distal sensory impairments

Question 9

The first neurologic symptom is often

Answer 9

paresthesia in the toes
This is followed within hours or days by weakness distally in the legs
Weakness spreads to the arms, trunk and facial muscles
Flaccid paralysis is accompanied by absence of DTRs
Occasionally sensory and motor symptoms start in the arms and hands first
In 50% of cases, palatal and facial muscles become involved; even muscles of mastication may be involved

Question 10

progression of symptoms

Answer 10

In 50% of cases, progression of symptoms generally cease in 2 weeks and 90% of cases progression ends by 4 weeks
After the progression stops, a static phase begins, lasting 2 to 4 weeks before recovery occurs in a proximal to distal progression. This recovery may take months or even years

Question 11

Diagnosis

Answer 11

Careful clinical and neurophysiologic examinations and laboratory tests are needed

Question 12

Treatment

Answer 12

Because GBS is believed to be an auto-immune disease, treatment has been aimed at controlling the response
Plasmapheresis – plasma is removed from circulation and filtered to remove or dilute circulating antibodies
High dose intravenous (IV) administration of immunoglobulin which is a protein the immune system normally uses to attack foreign organisms

Question 13

Although most persons recover, up to

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20 % can have remaining neurologic deficits. After 1 year, 67% of clients have complete recovery, but 20 % remain with significant disability.42 Even after 2 years, 8% have not recovered.

Question 14

Exercise

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When the person’s condition stabilizes, a therapeutic pool can be used to initiate movement in a controlled environment

Question 15

A major precaution during the early treatment phase

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is to provide gentle stretching and active, active-assistive exercise at a level consistent with the person’s muscle strength

Question 16

Overstretching and overuse may result in

Answer 16

a prolonged recovery period or a lack of recovery